Diagnosis of periprosthetic hip infection: a clinical update

Diagnosis of periprosthetic hip infection: a clinical update

Authors

  • Valentina Luppi a:1:{s:5:"en_US";s:24:"Santorso, Alto Vicentino";}
  • Dario Regis Department of Orthopedics and Traumatology, Azienda Ospedaliera Universitaria Integrata di Verona
  • Andrea Sandri Department of Orthopedics and Traumatology, Azienda Ospedaliera Universitaria Integrata di Verona
  • Bruno Magnan Department of Orthopedics and Traumatology, Azienda Ospedaliera Universitaria Integrata di Verona

Keywords:

Prosthetic joint infection, hip arthroplasty, biomarkers, microbiology, diagnosis

Abstract

Periprosthetic joint infection (PJI) is a serious complication following hip arthroplasty, which is associated with significant health cost, morbidity and mortality. There is currently no consensus in the optimal definition of PJI, and establishing diagnosis is challenging because of conflicting guidelines, numerous tests, and limited evidence, with no single test providing a sensitivity and specificity of 100%. Consequently, the diagnosis of PJI is based on a combination of clinical data, laboratory results from peripheral blood and synovial fluid, microbiological culture, histological evaluation of periprosthetic tissue, radiological investigations, and intraoperative findings. Usually, a sinus tract communicating with the prosthesis and two positive cultures for the same pathogen were regarded as major criteria for the diagnosis, but, in recent years, the availability of new serum and synovial biomarkers as well as molecular methods have shown encouraging results. Culture-negative PJI occurs in 5-12% of cases and is caused by low-grade infection as well as by previous or concomitant antibiotic therapy. Unfortunately, delay in diagnosis of PJI is associated with poorer outcomes. In this article, the current knowledge in epidemiology, pathogenesis, classification, and diagnosis of prosthetic hip infections is reviewed.

References

Kurtz S, Ong K, Lau E et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89(4): 780-5.

Sconfienza LM, Signore A, Cassar-Pullicino V et al. Diagnosis of peripheral bone and prosthetic joint infections: overview on the consensus documents by the EANM, EBJIS, and ESR (with ESCMID endorsement). Eur Radiol 2019; 29(12): 6425-38.

Kurtz S, Lau E, Watson H et al. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty 2012; 27(8): 61-5.

Shahi A, Parvizi J. The role of biomarkers in the diagnosis of periprosthetic joint infection. EFORT Open Rev 2016; 1(7): 275-8.

Tande AJ, Patel R. Prosthetic joint infection. Clin Microbiol Rev 2014; 27(2): 302-45.

Li C, Renz N, Trampuz A et al. Twenty common errors in the diagnosis and treatment of periprosthetic joint infection. Int Orthop 2020; 44(1): 3-14.

Rakow A, Perka C, Trampuz A et al. Origin and characteristics of haematogenous periprosthetic joint infection. Clin Microbiol Infect 2019; 25(7): 845-50.

Shoji MM, Chen AF. Biofilms in periprosthetic joint infections: a review of diagnostic modalities, current treatments, and future directions. J Knee Surg 2020; 33(2): 119-31.

Malhotra R, Dhawan B, Garg B et al. A comparison of bacterial adhesion and biofilm formation on commonly used orthopaedic metal implant materials: an in vitro study. Indian J Orthop 2019; 53(1): 148-53.

Tsukayama DT, Estrada R, Gustilo RB. Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections. J Bone Joint Surg Am 1996; 78(4): 512-23.

Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med 2004; 351(16): 1645-54.

Benito N, Franco M, Ribera A et al. Time trends in the aetiology of prosthetic joint infections: a multicentre cohort study. Clin Microbiol Infect 2016; 22(8): 732.e1-8.

Parvizi J, Zmistowski B, Berbari EF et al. New definition for periprosthetic joint infection: from the workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res 2011; 469(11): 2992-4.

Parvizi J, Gehrke T, Chen AF. Proceedings of the international consensus on periprosthetic joint infection. Bone Joint J 2013; 95-B(11): 1450-2.

Parvizi J, Tan TL, Goswami K et al. The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria. J Arthroplasty 2018; 33(5): 1309-14.

Osmon DR, Berbari EF, Berendt AR et al. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2013; 56(1): e1-25.

Shohat N, Bauer T, Buttaro M et al. Hip and knee section, what is the definition of a periprosthetic joint infection (PJI) of the knee and the hip? Can the same criteria be used for both joints?: Proceedings of international consensus on orthopedic infections. J Arthroplasty 2019; 34(2): S325-7.

Romanò CL, Khawashki HA, Benzakour T et al. The W.A.I.O.T. definition of high-grade and low-grade peri-prosthetic joint infection. J Clin Med 2019; 8(5): 650-62.

McNally M, Sousa R, Wouthuyzen-Bakker M et al. The EBJIS definition of periprosthetic joint infection. A practical guide for clinicians. Bone Joint J 2021; 103-B(1): 18-25.

Pérez-Prieto D, Portillo ME, Puig-Verdié L et al. C-reactive protein may misdiagnose prosthetic joint infections, particularly chronic and low-grade infections. Int Orthop 2017; 41(7): 1315-9.

Shohat N, Goswami K, Tan TL et al. Fever and erythema are specific findings in detecting infection following total knee arthroplasty. J Bone Jt Infect 2019; 4(2): 92-8.

Wagenaar FBM, Löwik CAM, Zahar A et al. Persistent wound drainage after total joint arthroplasty: a narrative review. J Arthroplasty 2019; 34(1): 175-82.

Alijanipour P, Adeli B, Hansen EN et al. Intraoperative purulence is not reliable for diagnosing periprosthetic joint infection. J Arthroplasty 2015; 30(8): 1403-6.

Carli AV, Abdelbary H, Ahmadzai N et al. Diagnostic accuracy of serum, synovial, and tissue testing for chronic periprosthetic joint infection after hip and knee replacements: a systematic review. J Bone Joint Surg Am 2019; 101(7): 635-49.

Akgün D, Müller M, Perka C et al. The serum level of C-reactive protein alone cannot be used for the diagnosis of prosthetic joint infections, especially in those caused by organisms of low virulence. Bone Joint J 2018; 100-B(11): 1482-6.

Chisari E, Parvizi J. Accuracy of blood-tests and synovial fluid-tests in the diagnosis of periprosthetic joint infections. Expert Rev Anti Infect Ther 2020; 18(11): 1135-42.

Bilgen O, Atici T, Durak K et al. C-reactive protein values and erythrocyte sedimentation rates after total hip and total knee arthroplasty. J Int Med Res 2001; 29(1): 7-12.

Shahi A, Tan TL, Kheir MM et al. Diagnosing periprosthetic joint infection: and the winner is? J Arthroplasty 2017; 32(9): S232-5.

Chen Y, Kang X, Tao J et al. Reliability of synovial fluid alpha-defensin and leukocyte esterase in diagnosing periprosthetic joint infection (PJI): a systematic review and meta-analysis. J Orthop Surg Res 2019; 14(1): 453-65.

Bottner F, Wegner A, Winkelmann W et al. Interleukin-6, procalcitonin and TNF-alpha: markers of peri-prosthetic infection following total joint replacement. J Bone Joint Surg Br 2007; 89(1): 94-9.

Shahi A, Kheir MM, Tarabichi M et al. Serum D-dimer test is promising for the diagnosis of periprosthetic joint infection and timing of reimplantation. J Bone Joint Surg Am 2017: 99(17): 1419-27.

Lee YS, Lee YK, Han SB et al. Natural progress of D-dimer following total joint arthroplasty: a baseline for the diagnosis of the early postoperative infection. J Orthop Surg Res 2018; 13(1): 36-41.

Ali F, Wilkinson JM, Cooper JR et al. Accuracy of joint aspiration for the preoperative diagnosis of infection in total hip arthroplasty. J Arthroplasty 2006; 21(2): 221-6.

Cipriano CA, Brown NM, Michael AM et al. Serum and synovial fluid analysis for diagnosing chronic periprosthetic infection in patients with inflammatory arthritis. J Bone Joint Surg Am 2012; 94(7): 594-600.

Bonazinga T, Ferrari MC, Tanzi G et al. The role of alpha defensin in prosthetic joint infection (PJI) diagnosis: a literature review. EFORT Open Rev 2019; 4(1): 10-3.

Renz N, Yermak K, Perka C et al. Alpha defensin lateral flow test for diagnosis of periprosthetic joint infection: not a screening but a confirmatory test. J Bone Joint Surg Am 2018; 100(9): 742-50.

Wyatt MC, Beswick AD, Kunutsor SK et al. The alpha-defensin immunoassay and leukocyte esterase colorimetric strip test for the diagnosis of periprosthetic infection: a systematic review and meta-analysis. J Bone Joint Surg Am 2016; 98(12): 992-1000.

Ahmed SS, Begum F, Kayani B et al. Risk factors, diagnosis and management of prosthetic joint infection after total hip arthroplasty. Expert Rev Med Devices 2019; 16(12): 1063-70.

Zheng QY, Li R, Ni M et al. What is the optimal timing for reading the leukocyte esterase strip for the diagnosis of periprosthetic joint infection? Clin Orthop Relat Res 2021; 479(6): 1323-30.

Deirmengian CA, Liang L, Rosenberger JP et al. The leukocyte esterase test strip is a poor rule-out test for periprosthetic joint infection. J Arthroplasty 2018; 33(8): 2571-4.

Tischler EH, Plummer DR, Chen AF et al. Leukocyte esterase: metal-on-metal failure and periprosthetic joint infection. J Arthroplasty 2016; 31(10): 2260-3.

Mihalič R, Zdovc J, Brumat P et al. Synovial fluid interleukin-6 is not superior to cell count and differential in the detection of periprosthetic joint infection. Bone Jt Open 2020; 1(12): 737-42.

Krenn V, Morawietz L, Perino G et al. Revised histopathological consensus classification of joint implant related pathology. Pathol Res Pract 2014; 210(12): 779-86.

Morawietz L, Classen R-A, Schröder JH et al. Proposal for a histopathological consensus classification of the periprosthetic interface membrane. J Clin Pathol 2006; 59(6): 591-7.

Bori G, Soriano A, Garcia S et al. Neutrophils in frozen section and type of microorganism isolated at the time of resection arthroplasty for the treatment of infection. Arch Orthop Trauma Surg 2009; 129(5): 591-5.

Bori G, Muñoz-Mahamud E, Garcia S et al. Interface membrane is the best sample for histological study to diagnose prosthetic joint infection. Mod Pathol 2011; 24(4): 579-84.

Bemer P, Leger J, Tande D et al. How many samples and how many culture media to diagnose a prosthetic joint infection: a clinical and microbiological prospective multicenter study. J Clin Microbiol 2016; 54(2): 385-91.

Makki D, Abdalla S, El Gamal T et al. It is necessary to change instruments between sampling sites when taking multiple tissue specimens in musculoskeletal infections? Ann R Coll Surg Engl 2018; 100(7): 563-5.

Aggarwal VK, Higuera C, Deirmengian G et al. Swab cultures are not as effective as tissue cultures for diagnosis of periprosthetic joint infection. Clin Orthop Relat Res 2013; 471(10): 3196-203.

Tetreault MW, Wetters NG, Aggarwal VK et al. Should draining wounds and sinuses associated with hip and knee arthroplasties be cultured? J Arthroplasty 2013; 28(8): 133-6.

Barrack RL, Harris WH. The value of aspiration of the hip joint before revision total hip arthroplasty. J Bone Joint Surg Am 1993; 75(1): 66-76.

Schafer P, Fink B, Sandow D et al. Prolonged bacterial culture to identify late periprosthetic joint infection: a promising strategy. Clin Infect Dis 2008; 47(11): 1403-9.

Romanò CL, Petrosillo N, Argento G et al. The role of imaging techniques to define a peri-prosthetic hip and knee infection: multidisciplinary consensus statements. J Clin Med 2020; 9(8): 2548-68.

Gemmel F, Van den Wyngaert H, Love C et al. Prosthetic joint infections: radionuclide state-of-the-art imaging. Eur J Nucl Med Mol Imaging 2012; 39(5): 892-909.

Sdao S, Orlandi D, Aliprandi A et al. The role of ultrasonography in the assessment of peri-prosthetic hip complications. J Ultrasound 2015; 18(3): 245-50.

Van Holsbeeck MT, Eyler WR, Sherman LS et al. Detection of infection in loosened hip prostheses: efficacy of sonography. AJR Am J Roentgenol 1994; 163(2): 381-4.

Signore A, Sconfienza LM, Borens O et al. Consensus document for the diagnosis of prosthetic joint infections: a joint paper by the EANM, EBJIS, and ESR (with ESCMID endorsement). Eur J Nucl Med Mol Imaging 2019; 46(4): 971-88.

Kwee RM, Kwee TC. 18F-FDG PET for diagnosing infections in prosthetic joints. PET Clin 2020; 15(2): 197-205.

Cyteval C, Hamm V, Sarrabère MP et al. Painful infection at the site of hip prosthesis: CT imaging. Radiology 2002; 224(2): 477-83.

Galley J, Sutter R, Stern C et al. Diagnosis of periprosthetic hip joint infection using MRI with metal artifact reduction at 1.5 T. Radiology 2020; 296(1): 98-108.

Love C, Marwin SE, Palestro CJ. Nuclear medicine and the infected joint replacement. Semin Nucl Med 2009; 39(1): 66-78.

Blanc P, Bonnet E, Giordano G et al. The use of labelled leukocyte scintigraphy to evaluate chronic periprosthetic joint infections: a retrospective multicentre study on 168 patients. Eur J Clin Microbiol Infect Dis 2019; 38(9): 1625-31.

Verberne SJ, Raijmakers PG, Temmerman OP. The accuracy of imaging techniques in the assessment of periprosthetic hip infection: a systematic review and meta-analysis. J Bone Joint Surg Am 2016; 98(19): 1638-45.

Glaudemans AW, Prandini N, Di Girolamo M et al. Hybrid imaging of musculoskeletal infections. Q J Nucl Med Mol Imaging 2018; 62(1): 3-13.

Tarabichi M, Shohat N, Goswami K et al. Diagnosis of periprosthetic joint infection: the potential of next-generation sequencing. J Bone Joint Surg Am 2018; 100(2): 147-54.

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Published

23-06-2023

How to Cite

1.
Diagnosis of periprosthetic hip infection: a clinical update. Acta Biomed [Internet]. 2023 Jun. 23 [cited 2024 Jun. 22];94(S2):e2023095. Available from: https://www.mattioli1885journals.com/index.php/actabiomedica/article/view/13792